The Impact of Choice: Heads Up! Breech Conference

Day 2:

Panel on The Impact of Choice

Panelists:

• Celine Ouellette (Ontario)
• Ruth Mace-Tessler (England)
• Cathy Harris (DC & Georgia)
• Kimberly Van Der Beek (Los Angeles)
• Benna Waites (England)
• Moderator: Robin Lim

From left to right: Benna, Kimberly, Cathy, Ruth, Celine & Robin. Photo from the Coalition for Breech Birth Facebook page

Celine Ouellette is from Deep River, Ontario, 2 hours north of Ottawa. She works in the child protection system. She is the mother of one daughter. When she was 34 weeks pregnant, her midwives discovered her daughter to be breech. By 36 weeks, she went in for a consult. Her midwives told her to prepare to have a cesarean. The midwives she had didn’t feel they had enough experience with breech. She was devastated and decided to advocate for a breech birth. A midwife in Ottawa was recommended to her; she spent hours talking about safety, risks, and mechanisms of breech. She tried 2 ECVs, did Moxi, chrio, inversions—nothing worked. By the second ECV, she accepted that her daughter wouldn’t turn. She enjoyed the rest of her pregnancy.

At 40 weeks and a few days, Celine woke up and felt a small leak. She called her midwife in the morning. She went to see the midwife in Ottawa; she was given antibiotics for GBS+ and sent back home to her community midwives. She also consulted with an OB who was supposed to be breech-friendly. During their meeting, he told her about a bad outcome in detail. Neither her husband or her midwife were there. She went about her day. Labor had started the next morning, so about 24 hours since SROM (later on in labor, her water broke again, so the first one was either a small leak that resealed or a rupture of one of the amniotic layers). She labored at home until 4 cm and went into the hospital around lunchtime.

The nurses didn’t want her to eat, but she was hungry so she did. Around 1:30 pm, the on-call OB (one she hadn’t spoken to) recommended Pit in a few hours and then a c=section. She said, “I’m just getting started and we’re not talking about that right now.” The Ottawa midwife was there but couldn’t attend to her because of hospital policy. Celine refused the offered Pitocin. Around 4:40 pm, the OB recommended Pit again, and she agreed to it. She did 2 hours of Pit. A few hours later, she did N2O2. She’s progressing slowly. She felt she needed to be on hands & knees and couldn’t have an epidural. She kept watching the clock, waiting for the breech-friendly OB to come in. He finally comes in and checks her around 9:30 pm. He wasn’t comfortable with how things were going and recommended a cesarean because of membrane rupture, EFW was near the upper limits, and GBS+. Her husband was devastated and unable to provide support at that point. She couldn’t see any way to do things differently.

Celine asked for a few minutes to think, and she talked with her midwife. She reluctantly consented to the cesarean. The midwife checked her again and said “I can feel a change; I’ll be right back!” Celine tried one last time to argue for the possibility of a vaginal birth, but the OB said she was likely to end up with a traumatic delivery and forceps. She knew she couldn’t do that to her baby. Even though the midwife had discovered some change in her labor progress, at this point she felt trapped and went through the CS anyway. Her midwife stayed by her side the whole time.

Her daughter wasn’t over 4000g. She had the cord around her neck twice, which might not have been a big deal anyway. She feels she would have been fine if she’d been given a fair shot. Care providers need to know that almost 2 1/2 years out, she still can’t get through her birth story without crying. It will continue to affect her throughout any future pregnancies. It wasn’t just her birth. It was her experience of becoming a mother.

Ruth Mace-Tessler lives about 2 hours outside of London. She had one baby born in 2009. She commented, "It’s not so much the actual birth, but the whole picture leading up to that point, that dismays us." She found out her son was breech around 28 weeks. Time passed, and he was still breech. She felt excited: “I like a challenge; I can do this!”

Her sister was very helpful, recommended a doula, and gave her Jane Evans’ book on breech. She saw nine different midwives prenatally, so she had no continuity of care. She had to explain over and over the same thing. She had an U/S at 37 weeks at the hospital. She were booked under a consultant who wasn’t breech friendly, and she never saw him, just one of his junior doctors. He asked her, “So, ECV or section?” She said, “no thanks.” He then presented her with a big list of risks of breech birth. They went home feeling more bemused than anything else.

At 41 weeks, Ruth saw a new midwife who expressed support for her plans. She hit 42 weeks. She was starting to get pressure to have an induction, but she waited and labor began spontaneously. She wanted to stay home for as long as possible, where she felt safe. Nobody else felt comfortable, though. She kept getting unsolicited phone calls from various midwives who weren’t comfortable with her plans. They kept telling her all the things that could go wrong—while she was in labor! Every time she’d get a phone call, her labor would stop. Her husband lost it and started crying. At that point, she got a knock on the door; it was another midwife she didn’t know who had turned up because she was her team leader. The midwife came into her bedroom. Ruth told her, “At this point, I’m feeling harassed!”

They eventually went into the hospital. The minute Ruth got there, there was a senior midwife who was very experienced with breeches. This midwife was quite wonderful and supportive. At that point, Ruth had been laboring a long time and she was really tired. Contractions started to peter out, and the midwife said, “I think we need to think about other options.” Ruth broke down and cried. Her baby's bottom was already beginning to show. They did move to surgery, and it was so for Ruth hard to deal with the contractions knowing that they weren’t going to lead to a vaginal birth. She still feels really sad; maybe if she’d gone in earlier on and spent more labor time with the supportive midwife...maybe she’d have had a vaginal birth.

Cathy Harris is the mother of two children and lives in the D.C. area. Her first baby was born in a birth center in Virginia. That was her perception of normal; she knew how wonderful and beautiful birth could be. Her breech birth with her second baby took place when she was living in Georgia. Unfortunately, there were few options for breech there. Her breech son is now 13 months old. For this second baby, she planned on a natural birth in a hospital, since there were no birth centers in her area of Georgia. She really wanted a water birth the second time; "If I can stay underwater for as long as possible," she thought, "people can’t bug me." She’a also a childbirth educator, and she started teaching for an OB's office. She really liked the group of midwives & OBs in that practice.

At 39+4 weeks, she discovered her son was breech. In the back of her mind, she had known something was different and had been saying so the last few weeks of prenatal visits. She finally insisted on an ultrasound, and the baby was indeed breech—and a footling. She immediately tried to do everything she could to get her baby to turn. She convinced her OB to give her another week. She met with another doctor and a home birth midwife. A day before her scheduled c-section, she met with her OB and asked for more options, for the possibility of a VBB. They said absolutely not; you have to have the c-section.

The day before, waiting for her c-section the next day, was probably the worst day of her life. She knew what giving birth could be like. She knew inside of her that she had the strength to birth her baby. Her husband didn’t even understand it—knowing she was going to have to go in and relinquish all control to people she didn’t know. In contrast, her first birth felt like it was hers. Right before the surgery, a new nurse came in and said, “Do you have a birth plan with you? I want to know your original plan was so I know how to help you and so you can be empowered to breastfeed your baby.” This gave her a lot of peace during the surgery. She also made it very clear to the people in the room that the surgery was not what she had chosen. After her c-section, she took to breastfeeding the way she’d taken to her first birth; it was what she had control over. That was where she found her empowerment. It was one of the best and one of the most horrible days of her life.

Kimberly Van Der Beek (wife of actor James Van Der Beek) shared her two birth stories recently on a People blog. For her first baby, she’d been talked out of her dream of having a home birth and ended up with a more medicalized experience in a hospital. With her second baby, she found her son was breech at 37 weeks. She was very naive and didn’t even assume that meant a c-section. However, her doctor said it was absolutely not possible to have a VBB. She tried everything to turn the baby. Her chiropractor recommended 2 options: one OB who does routine epidurals, inductions and forceps for breeches. Or Dr. Fischbein, who does them at home. She was thrilled to hear that. She listened to everyone’s fears, tried to be a reasonable person, and asked questions. She realized there were risks with every choice. You need to know that you’re assessing risks vs risks, not risk vs no risk.

A few days after she’d switched providers, Kimberly received an email from her original OB expressing her worries and fears. She wrote to Kimberly: “Your child, I’m afraid, is going to have problems with fetal stress. God forbid, he could die, and I’m very concerned. I think you need to schedule a cesarean for Saturday.” This was one of the most natural-friendly doctors in LA writing this letter. Despite these obstacles, her husband was always a tremendous support.

The following Monday at 3 pm, her water broke. Dr. Fischbein confirmed rupture of membranes, checked that everyone was fine, and told her to call him when labor began. She took a bath, spent some special time with her daughter, and went to bed. At 5 am, she woke up with a really strong contraction. They were 3 minutes apart, strong, and long within half an hour. Her doula and midwife arrived—she was 9 cms. (Dr. F was with another laboring breech mom 65 miles away!) Her body began pushing, but she tried her best to wait for him to come. When he arrived, he was very casual and relaxed. He let her go into the zone and do her thing. Kimberly told the audience--specifically the maternity care providers-- "In the future, let us go into our zone." She also noted how being in a comfortable environment helped her find the strength she needed: “When you’re in your own bed, with the sun rising, you can go there. You can make it happen.“ Her son was born at 7:42 am. She concluded by asking, "How can I help this process along? If I can do anything to help, let me and my husband know."

Benna Waites, author of the 2001 book Breech Birth, (I reviewed this book back in 2008) had a breech baby born in 1998. At 36 weeks, the conversations started. He’d been breech for a while, but everyone said “he’ll turn, he’ll turn.” She’d read enough to know that the evidence supported VBB as an option. This was pre-TBT. She’d also seen pictures of an upright breech birth and felt that made sense. Her partrner had passed out while watching a c/s video, so they were both very keen to avoid surgery if they could. The consultant they saw said that cesarean is best for the baby. She disagreed and said her reading of the evidence indicated otherwise. He said, “Okay, but we’ll do it in lithotomy and use forceps.” It sounded "medieval" to her. It wasn’t something she could do.

She went through mourning for the loss of her lovely, peaceful pregnancy. She also mourned for her colleagues. She’s a psychologist and evidence-based medicine was a big thing in her field. There was something shocking about obstetricians lying to her. “I was angry, not just scientifically disappointed.”

Benna lived on the edge of London and began phoning hospitals and midwives. She also spoke with some independent midwives. Finally, she contacted an OB at King’s College Hospital, Donald Gibb, who was known to be progressive. He was really up for doing an upright vaginal breech birth. She described him as "committed and quite keen." But he had lots of international conferences. He said, “I can’t guarantee that any other consultant will give you a TOL on all-fours, so I’ll come in for your birth as long as I’m in the country.” Incredibly enough, she went into labor when he was in the country.

Like many of the other panelists, Benna commented that "It was the struggle that was so important. The birth itself was the most normal, natural, straightforward part of the process." This hospital wasn’t the most beautiful place in the world. Her attending midwife (present while Dr. Gibb was on the way) was quite frightened. Dr. Gibb and her partner gave her fantastic support and confidence. Labor went smoothly. Her son was born spontaneously on all-fours in front of a vast audience; she wanted others to observe so they could share that knowledge. This experience set up her journey into motherhood with a cause for celebration, not mourning.

This also spurred her to write the book Breech Birth. It was a 2-year project, finished in 2001. It reviewed all the evidence available about breech birth at the time. Her main message for OBs who only look at the TBT is that “your ignorance and your fear cannot be the reason for our lack of choice. That is not okay.”
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Birth Around the World: My Alien Baby

Inspired by Brieanne's story of giving birth at night to the sound of coyotes, Anna wrote a generational saga of two births – her own arrival in Azerbaijan, and her daughter's birth in the USA. Anna has been a blog reader for several years. She wrote to me:

Your blog was my gateway to the birthing blog world. Ten months ago, I gave birth to a baby girl in a homebirth-turned-unplanned c-section. I was so excited about birthing my baby at home. The c-section was incredibly traumatic. I have been working on recovery since the birth. As my daughter's first birthday approached, I felt a more urgent need to heal spiritually from her birth.

Writing the story has helped enormously – writing down my anger at God for letting this happen to me has allowing me to slowly let go and grow in my compassion.

Besides writing the story, I have been working on several writing projects, including my blog. In one way or another the majority of my writing is prayer for my daughter. Her soul was unable to enter this world peacefully, writing for her, addressing my writing to her in the final sentence is my way of sending her divine peace.

Writing is my prayer.

Anna blogs about faith, feminism, and spirituality at Sotah.

*****

My Alien Baby

I believe that is possible to birth yourself.

That I can get down on all fours, open my womb, and emerge from within – whole.

My mother birthed me in a small hospital in Baku, Azerbaijan, a hospital that by all accounts (and by all accounts I mean my mother’s account) was a third world shithole. She was there for three weeks before my birth in a high risk ward, because I was Rh+ and she was Rh-, a potentially fatal mix without a RhoGAM injection. Though it had been available in the west as a routine matter for women at risk since 1968, it was not available in the Soviet Union, even in 1984. Ten thousand babies a year are saved by a RhoGAM injection to the mother. This terrible combination of lacking the real cure, RhoGAM, and still attempting to be helpful overtook the medical establishment. And so, listening to the advice of her doctors, my mom checked herself into a hospital a week before she was due and spent the next three weeks living in a room with a dozen high risk women, whose babies, generally, did not make it. Three weeks of the dead baby parade – followed by labor, alone. Visitors wore not allowed in soviet maternity wards. My mother is laboring alone with her first (and only) baby, knowing little about birth. She has never been to a birth or seen a video of a birthing woman. There were no birthing classes for her to attend.

On the shores of the Black Sea, in the small town of Sudak, Ukraine, a radical apprentice trained midwife, Elena Tonetti-Vladimirova, is running birthing camps where hundreds of women are coming to birth in the sea’s shallow lagoons with the dolphins. There is available footage of eleven of these births in a documentary called Birth as We Know It. These images are alive. I am wet with the ocean water. Elena talks about the spiraling motion of galaxies and of our hips: they are the same.

I am born in the hospital, finally. We are drugged and I am sluggish in the birth canal. The doctors cut an episiotomy. It will be stitched up without drugs – female genital mutilation. I was born after six hours of labor, a short labor for a first birth. No one ever asked my mother to draw her birth energy with washable crayons on white poster-paper, such things did not exist for her in Azerbaijan, and yet there was Sudak and the dolphins.

Three days after my birth and after bribing a nurse, she was finally able to see me. Another woman was breastfeeding me for those three days. Was I lying there, mostly alone, for my first three days? I feel petty wondering how this birth affected me – how I might have been different if I was born into the sea. If my mother welcomed me on to this good earth and laid me on her chest and snuggled my gooey, vernix covered, unfurled newborn body? Would I then have peace?

My mother told me the story of my birth many times – I have always known this story. It is a sad story of the pathologizing of birth. It is a typical story of modernity gone wrong – characterized by an authoritarian imposition of power acting upon the most vulnerable, a laboring woman and her infant.

I need a radically different story to tell the un-born creature; to tell myself. In the Torah, the Hebrew Bible, characters are constantly rebirthing themselves in new stories. Each new story is a tikkun, a metaphysical and proverbial fixing of the story that came before, a rebirthing of itself. I want a tikkun for myself and for Eve, who was cursed to bear children in pain. In an inflatable kiddy pool, decorated with fish drawings, on the second floor of my DC apartment, I would undo Eve's curse with my very own birth. There would be no dolphins and no black sea, only my inflatable pool where I would know God in the moment of her birth – a creature emerging from between my legs. Z, welcome to the good earth.

*****

At five am, when I get out of bed to pee, my water breaks like it does in the movies. Many women labor the entire time with their amniotic sac intact, only to have it break at the very end. Some women's water never breaks - the baby is born in caul; this is auspicious. Babies born this way are believed to have shamanic powers in some cultures, including in medieval Europe. My water just burst open, gushing down my legs. It bursts clear and beautiful. I cannot feel any contractions. And as the amniotic fluid continued to leak out, the color changes from clear to yellow to green. Meconium

It is a sign of fetal distress – routine in late stages of labor, but abnormal at the start. My midwife arrives and I know what she is going to say – hospital. I did not pack a hospital bag. I bought home birth supplies instead; gloves, gauze, wash clothes, dozens of receiving blankets in a warmer, mesh underwear, chuck pads, plastic sheets and umbilical tape. I spent the previous week trying to make sure I had the right connector from the water hose to the sink, so the inflatable pool could be filled. I did not pack a hospital bag.

I mourn the birth I will not have – the peaceful, undisturbed birth in the dark, on my knees. The earth, the Universe, God, all of you, how can you let this happen to me? I am so sad. I cry for the next four days – I cry till I am finally home, and then I cry some more. I can barely walk around the block. I am scared to shower alone. I cannot lift my baby from her bassinet – it’s too deep. I go to a shrink and she tells me that I am turning birth into a contest, that it is not my fault. I never go to her again. I don’t blame myself – I blame God. Hospital-pitocin-epidural-csection-hospital-potocin-epidural-csection-hospital-pitocin-epidural-csection. I was going to be a mystic, a seer, a conduit for the energy of the earth, spiraling my hips like the galaxies: I wanted to be a birthing woman.

I read a story of a woman giving birth, squatting on the cold hard earth, howling with the coyotes. I wanted to howl with the coyotes and dance with the moon. I wanted Z's birth to be the exact opposite of my own – no fear, no pathology, no suffering. I dreamt of my birth, imagining the opening of my womb – until she and I emerged on the other end. I was thrilled that Z was female, perhaps, one day she might find herself dreaming like this – dreaming of her own birth.

This was not my way – not this time.

Z was born in the hospital operating room. The operating rooms are insanely cold (for the prevention of infection they told me). I was shivering on the operating table, warming blankets all over the body parts I could feel, mostly my arms and neck. There was no way Z could stay in that room for more than a moment, wet and new, simply because it was far too cold for her. She screamed when she was born – the TV scream, loud and distraught. I held her three hours later – after she was cleaned and the IV port was inserted. She was wrapped in the blue and pink stripped blankets – appropriate for both females and males. I saw the babies in the nursery wrapped in the special blankets their parents brought – we did not think of bringing any special blankets. When the nurses brought her, I read the number from my hospital bracelet, and then they give her to me. My baby.

Maybe Z is an alien. C-sections are really an alien invasion, where our human babies are being taken by the aliens, and they are sending instead little aliens, disguised as babies to study us. Z is sending back messages to her home planet, I hope she likes us and we will be spared when the invasion comes.

I am sad because I did not see her emerge from between my legs. It disconnects me from my body, leaving me wanting for prophecy and vernix; for words, for my placenta, which I did not make prints from. The prints I have seen look like trees. I never saw my placenta. Was it more like a maple or a spruce?

My first nurse after surgery was wearing a gorgeous cap – brightly colored, absolutely fantastic. I love nurses who accessorize their uniforms. She had three c-sections. She tried to birth her first two babies; with the third she scheduled the c-section from the start. Michelle Dugger, a mother of 19 children with a show on TLC, had twelve children vaginally after a c-section. Did she howl with the coyotes when she opened again during the birth of her eighteenth baby? Do her hips spiral with the energy of galaxies? Her nineteenth baby was a preemie and a c-section. She was due the same week as Z, but born over two month earlier. Z and Josie Brooklyn are the same real age – both aliens.

The c-section scar is surprisingly small, a thin line only three inches long. The doctors put their hands in this small wound took out my baby, feeling good about themselves. A textbook c-section and healthy baby. The doctors do not know what I am mourning for. I wanted to birth us both, on my knees on the dirt, howling at the moon with the coyotes, and swimming in the sea with the dolphins in my DC apartment. Would the doctors be sad if they knew?

Z, my c-section alien baby, happy birthday – welcome to this good earth.

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All that matters...

And all that matters is that you have a healthy and safe delivery... no matter how it's done.

All that matter is a healthy baby and healthy mommy.

Whatever happens, what matters most is a healthy baby girl and a happy mama and daddy.

In the end, all that matters is bringing a healthy baby into this world, by whatever means necessary.

These are all real statements I came across one day last week.
 
I find these statements both tyrannical and tautological. Tyrannical because it leads to a restriction of choices in the name of safety. Tautological because *of course* mothers want their babies to be born healthy and want themselves to come out of the process unharmed.

The "healthy mom/healthy baby" rhetoric, if followed to its logical end, leads down several ridiculous and contradictory paths.

First, it allows widespread abuse and manipulation of birthing women by negating anything that happened in the course of the birth, as long as the mom and baby survived. (Because in this context, "healthy" is a euphemism for made it out alive, not necessarily thriving and vibrant and injury-free.) It excuses any and all deviations from principles of evidence-based medicine and informed consent. And ironically, it often leads to greater net harm. Why? Because the "healthy mom/healthy baby" rhetoric is usually used to justify increased medical intervention. Pressured to have a c-section you didn't want or need? Encouraged to have an induction for dubious reasons? Given an episiotomy even though you clearly said you would rather tear? You should be grateful, because all that matters is that you have a healthy and safe delivery... no matter how it's done.


Second, it creates a false dichotomy between Good Moms who do the Right Things (like doing whatever their care provider says without asking questions) and Bad Moms who care more about The Experience than their own and their baby's wellbeing. You know, the hedonistic, selfish, narcissistic moms who'd rather listen to Enya and labor in an Aquadoula than have a living baby.

Third, it creates an artificial hierarchy of women's wants and needs, in which the mother's--and especially the baby's--health cannot coexist equally with other goals. Goals such as feeling respected and honored and joyful during the birth process, being able to make decisions about their care, and emerging from the birth feeling powerful and confident.

Fourth, the healthy mom/healthy baby idea opens the door for dictatorial top-down decisions. Because if the most important thing is a healthy mother and a healthy baby, then logically anything that adds additional risk to mother or baby should not be allowed. Let's follow this logic down its slippery slope to the final, authoritarian end:

• No epidurals or pain medications except for surgical births, because they add medical risk with no medical benefit (no one has ever died from the sensations of labor, but there are a host of risks--from minor to deadly--from epidural anesthesia and IV narcotics).
• No elective inductions.
• No elective cesareans.
• No home births (if you believe there is increased risk to the baby).
• No hospital births for low-risk women (if you believe there is increased risk to the mother and/or baby from standard hospital and obstetrical practices).
• No VBACs because they have a slightly increased risk to the baby.
• But no repeat cesareans because they are riskier for the the mother and sometimes the baby as well...So if you have a cesarean, you are not allowed to have any more children, since both VBAC and ERCS carry risks, and risk to either mother or baby is not acceptable. After all, the most important thing is a healthy mom and healthy baby.

See how ridiculous this is becoming?

I'm not saying that I don't value a healthy mother and healthy baby. On the contrary. It's just that the "healthy mom/healthy baby" rhetoric serves as a smokescreen. I'm thinking back to a comment by a family physician whom I am honored to know. She attends births as part of her family practice and has four children of her own:

I know as a mother that I would do anything to have my children whole and healthy (and I'm so blessed that they are!). I would have 10 cesareans, I would take any intervention, I would walk on hot coals. But it doesn't mean that we should require everyone to have every intervention known - or even that that would be the safest for everyone. I would take any intervention to have a healthy baby if it was needed, but that doesn't mean I should have every intervention no matter what.

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One day of google reader

I subscribe to lots of blogs. Too many. I also have Google Alerts set for various search terms. On the days I don't blog, it's usually not for lack of something to write about. It's the other way around, actually--blogging paralysis caused by information overload.

Here's a sampling of things that caught my attention today, ones that I bookmarked for later posting/viewing/reading/commenting.

Jenne at Descent into Motherhood discussed what birth trauma looks like (and what it does not look like), using pictures from her own two births as examples. I love looking at contrasting pictures of births, such as this woman who had two cesareans and finally, in her words, a "victorious birth after multiple cesareans." Or this link I followed from Jenne's blog to Comparison at Aimeeland. Any other photo/video comparisons you'd like to share?

Women in Charge, a home birth midwife's blog, shared two birth stories in one. The mom's first baby was born at home, then her twins were born in a hospital. Nice to read such a great story, but it's one of those lucky stories that many mothers of multiples don't ever get a chance to experience. 

Molly at First The Egg (formerly Feminist Childbirth Studies) finally unmasked herself. She shared her frustrations with the subtle discrimination towards mothers in academia, something I totally can relate to:

I work in an extraordinarily competitive field in which no one’s really supposed to have interests outside scholarship and teaching (in that order, preferably). There is a reason that it’s illegal for hiring committees to ask whether a candidate is married, has kids, is planning a family, etc. Much the same reason that women in my profession try really, really hard not to be pregnant on the job market (it’s much harder to hide your parenthood when you have a huge belly rather than a child who can be left at the hotel with another caregiver!). People really do discriminate–largely unconsciously, I’d bet–against women with small children....

The subtle and not-so-subtle codes that say it’s okay–admirable, even–to be and talk about being an involved father, but a sign of poor work ethic or inadequate professional commitment to be and talk about being an involved mother. The coding of childbirth and parenting as ‘women’s work’ and as special interests rather than as fundamental elements of human experience and cultural systems.

And lots of stuff about breastfeeding--in particular, the recent study in Pediatrics that concluded: " if 80 to 90 percent of women exclusively breastfed for as little as four months and if 90 percent of women would breastfeed some times until six months," the US would save $13 billion in excess costs annually and avert 911 preventable deaths per year.

Responses to this article--and there are tons out there, so please share your favorites--include:

• Jenne at Descent Into Motherhood: Vitriol over breastfeeding research. I love the comment that "Ideals are stars to be guided by not sticks to beat ourselves with."
• The Feminist Breeder: When it comes to breastfeeding, we can't handle the truth

Dou-la-la alerted me to a new film, Latching On, and gave some commentary. Bellies and Babies also mentioned that documentary, as well as another one titled My Toxic Baby.

Every day is like this...so many interesting things to read share and never enough time to get to all of them!

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Investment

Investment

by Carol Lynn Pearson

How enviously
I watched
The rose bush
Bear her bud --
Such an easy
Lovely birth.
And
At that moment
I wished
The sweet myth
Were true -
That I could
Pluck you
My child
From some
green vine.

But now
As you breathe
Through flesh
That was mine,
Gently in the small circle
Of my arms,
I see
The wisdom
Of investment

The easy gift
Is easy to forget.
But what is bought
With coin of pain
Is dearly kept.

Carol Lynn Pearson is a Mormon author and playwright. Read more about her here.

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International Women's Day

Today is International Women's Day--a time to celebrate women's achievements and to honor the women in our lives.

I found a particularly touching IWD post by Gisele Bundchen, called A gift from life. She wrote:

I grew up witnessing my mother always trying her best at doing all she could for the 6 of us girls. My mom devoted her entire life to her family and did it with such grace. She couldn’t have been more of a loving and caring mother. She is my hero. She is the reason why I believe that a woman is the core of a family… I can only hope to be for my kids what she will and always be for us… Our Rock.

Being committed to building a family, becoming a mother and raising a child with love and awareness is for me, the single biggest responsibility a woman could have. Giving birth was the most intense and life-changing experience of my life. I am blessed to have been able to have a home birth surrounded by love, where I was able to feel safe. It was a powerful experience. I never felt so vulnerable but so strong at the same time. It was amazing to experience my body become free to do what it was made to do by allowing my mind and my body to let go and be free to experience the changes taking place within… I was just there… focusing on my breathing and relaxing the best that I could… so present, to witness the biggest miracle in my life happen before my very own eyes. To give life to another being, what a gift!

Read the rest here. (And I'm loving Gisele's blog--it combines mothering, conscious living, and environmental stewardship.)

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How to get a father on board with your birth plans

My college friend Jane of Seagull Fountain has been working her way through the stack of books I sent her. Her reading prompted a blog post Does it matter how you give birth? You'll enjoy joining in the conversation over at her blog.

I've written a few things recently about this topic in Thinking, no conclusions yet and Why does birth matter? (guest post). The comments sections in both posts are definitely worth reading.

Jane emailed me yesterday asking how to get her husband on-board and supportive of her plans for a natural birth. She's had three children, three epidurals (not super great ones, possibly because of her mild scoliosis), and two inductions. This time she wants to do things differently. Here's what she wrote:

So, I am getting sucked into these books. I read Baby Catcher first and thought it was fantastic! Then I tried Pushed and got bogged down in negative details. So I switched to The Thinking Woman's Guide, and loved how simple and informative it was. Now I wonder if I need a doula, and I have a bunch more questions for the midwife I just met (and liked) today; it's a midwife (8 of them)/OB (4 of them) practice and deliver in the hospital's birth center.

But my pressing question tonight is -- do you know of any natural childbirth podcasts and/or other resources for a father who doesn't seem very interested in or committed to supporting the laboring woman (me)? I will probably never succeed in making him understand why this is so important to me, but I wonder if you have any suggestions, because I need his unconditional support, even if he never truly understands.

What would you suggest for someone in her situation?

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Sick

Zari, Dio, and I are all sick (deep, racking cough and fever). So all I've been doing for the past few days is hold sick kids in my lap, read them stories, and nurse. Dio has been exceptionally snuggly and doesn't want to be put down. Just hoping we all feel better soon...it's no fun not being able to fall asleep till 2 am because you're coughing so much.

A few things that caught my attention:

Speak up at the NIH Consensus Conference on VBAC this March. Amy Romano at Science & Sensibility discusses some of the issues that will be on the table.

It's Turkey Time--aka time for the Second Annual Turkey Award from the Well-Rounded Mama. This year's award goes to Abe Sauer's article "Fat, Fetuses, and Felonies." You'll be astounded at the outrageous statements Sauer makes about overweight pregnant women.

A lovely unplanned home birth on Christmas Eve. Her father, a family practice doc who does OB, was there to catch the baby. My little sister knows this woman (or of her, at least; they went to the same congregation in Cambridge before she moved).

Sheila Kitzinger discusses the problem with "fairytale expectations" of birth.

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Joyful news

If you've been watching CNN, you probably saw that Arizonan mom Joy Szabo had a successful second VBAC--but not without a fight and a 6-hour temporary move away from her family. I blogged about her story a few months ago in Elective(?) Repeat Cesareans. Take the time to read the CNN story (which includes links to other stories and articles) and watch the video about "How to get the birth you want."

Reality Rounds has responded to the news of Szabo's VBAC, wondering if the public might see her story as one of (selfish) entitlement, rather than empowerment.

CNM and MPH Nicole Deggins of It's Your Birth Right just blogged about what patient empowerment means to her. Her favorite thing about attending births is when she sees "The Shift." It happens after a laboring woman is ready to throw in the towel, after she is sure she can't do this anymore. Then..."The Shift" happens and the dynamic changes:

Immediately after “The Shift” she gets a surge of energy from somewhere and then WOW! The miracle of birth and life happens. And as she delivers her baby, she realizes that YES not only could she do it...she just DID it and the pride, the energy, the happiness, the beauty of it all. OMG!!! If we could put it in a bottle we could send love and stop war around the globe.

She has a lovely story of a young teenage mother with lots of emotional and personal baggage, a "social history that had worn her down." But she found her voice and her inner strength through giving birth.

My bottom line on the Szabo drama: it's a great story of one woman's empowerment, determination, and courage to follow what she feels is right for her and her baby. But it's a story that shouldn't have happened in the first place. A pregnant woman shouldn't have to move six hours away and rent an apartment in a big city, away from her home and family during the final weeks of pregnancy, just to escape an unnecessary surgery that her local hospital would have forced on her by court order.

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Why does birth matter?

This is one response to my earlier post Thinking, No Conclusions Yet, from Jenny Parratt's PhD research about how birth affects a woman's embodied self. 

~~~~~

I found this post and all the comments very interesting. I'm a mother and a midwife and I feel passionate that the actual birth experience does matter. I have spent the past 9 years researching women's experiences for my PhD with Professor Kathleen Fahy (at Newcastle Uni in Australia). My focus has been on how women's embodied self changes during childbearing. The 14 stories I collected for the research give a very detailed picture of women's experience before during and after birth. I've recently published them (called Feelings of change: Stories of having a baby). I don't give any commentary with the stories because they are pretty long the way they are, but I plan another book that shows my findings.

Briefly, here are some of the findings from my PhD (cited below). My findings indicate that any woman can experience an improved sense of embodied self as a result of childbearing generally and childbirth more specifically. Embodied self change that is most empowering occurs when a woman uses her own power during labour and birth. This process of change is facilitated by a sense of self-trust and by being inwardly centred. A woman’s improved embodied self is then manifested by an increased awareness of and capacity to use her inner strength. This has the consequence that a woman who experiences a sense of improved embodied self feels more confident in dealing with other challenging life circumstances. I therefore conclude that when a woman uses her own power during labour and birth she is most likely to feel an improved sense of embodied self during childbearing.

Parratt, J. (2009) Feeling like a genius: enhancing women’s changing embodied self during first childbearing. PhD Thesis. School of Nursing and Midwifery. The University of Newcastle, NSW, Australia
Parratt, J. (2009). Feelings of Change: Stories of having a baby. Raleigh: Lulu.com.

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Thinking, no conclusions yet

I like reading things that make me think, hard. That make me examine my assumptions and evaluate what I'm doing and why. Things like one day in a life by Sweet & Salty Kate. I have a lot of complex responses to her post.

I fall somewhere inbetween the "you can't plan or control anything; birth is just one day and mothering the baby afterwards is the most important thing" camp and the "your birth is the most important event in shaping your life as a mother" camp. I think it's because birth itself is so complex and multi-faceted. There's the unpredictable, wild, ferocious nature of birth--sometimes generous, sometimes harsh and unforgiving--that we can never adequately plan or prepare for. That's where Kate, and many of her fabulous commenters, are coming from.

But there's also the reality that certain choices generally--not always, but often--lead to certain consequences. If you choose an elective induction at 38 weeks with a closed cervix...chances are you'll end up with a highly interventive labor and a c-section because of the failed induction. If you seek care with a midwife or physician who has a low cesarean and intervention rate...chances are you'll have a smooth, uncomplicated, spontaneous labor and birth. If you seek care with a busy OB practice with an assembly-line approach to pregnancy and birth...chances are you'll be sent down that assembly line too.

But in all of those cases, there will always be exceptions and surprises. And there's where it can be so hard to make any kind of generalization about birth. Because there are women who have elective inductions at 38 weeks with a closed cervix and their baby pops out after a quick labor. Because some women will have highly complex, complicated births even when they're planning for it to be as natural as possible. Because some women are extremely satisfied with their assembly-line care and rave about how fantastic their OB was. So whenever you try to say anything definitive about birth, someone will always pop up with an exception.

In Jan Tritten's case, the sentence that prompted Sweet & Salty Kate's post was poorly worded. I understand, though, why she might have said something like this. After all, her life's work surrounds birth. She's a midwife and editor of Midwifery Today. In her world, birth is highly significant, often the pivotal event in a woman's life.

I was wondering: how would I say that my children's birth ranks in importance in my life? It's hard to quantify. My own journey wasn't just about "the birth," but the entire process of thinking and researching and planning--not just for the tangible, physical birth itself, but also for the spiritual process of becoming a mother. I deeply treasure the memories of my children's births. I love that my labors were experiences predominantly of love, peace, and calm. I love that I was able to meet and overcome the challenges of labor and birth and find strength in other areas of my life, knowing that if I could give birth to a baby I could certainly do ___ (run a half marathon, finish my dissertation, etc).

Making a woman's birth as positive and empowering and enriching as possible is important. Why not strive to make every birth as good as it can be? Why make anything unnecessarily difficult or painful or traumatic? But of course giving birth isn't the one definitive moment for all women, even though for some women it is. If you speak to the women at Solace for Mothers, you'll learn how a traumatic birth experience can haunt someone for years. If you were at the International Breech Conference, you heard women still deeply affected by their birth experiences, years after the fact.

So how do we reconcile the complex natures of birth--the parts that you can't plan for, and the parts that you can?

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Iron in my soul

Becoming a parent can transform both mothers and fathers. A few months ago, I shared the story of a new father who played delivery room football in order to keep his daughter by his wife's side. A short excerpt from his story:

On the other side of the room, beyond the pediatricians, I could see the tears in my wife’s eyes as she watched her only child being taken away before she had a chance to even see or touch it. In the doctor’s arms I saw Lauren’s mouth making sucking movements. I felt the irreplaceable seconds ticking away and could hesitate no longer. I stepped forward and extracted her from his arms. “You get the papers, and I’m taking my child.”

British midwife Mary Cronk recently reminisced about "the first time that the iron entered my soul." Her first baby, born via forceps, was about to be put in the nursery for a standard 48-hour stay. Mary put her foot down and demanded that her baby remain with her:

40 odd years on I can still feel the emotions I had then. I ordered that my baby be brought to me immediately and informed them that I was my baby’s legal guardian and if he was not brought to me instantly, my husband would be instructing solicitors and bringing an action against them for kidnapping. I was so angry and hysterical, I suppose it was because I could not physically go to my baby that I was so upset. He was brought to me and I ordered that he be put alongside me. They obeyed me. But I was visited by Matron who reprimanded me as if I was a pupil midwife again. I repeated myself that I would observe my own baby and he was not removed from me again. I think that was the first time that the iron entered my soul and I realized that parents had rights.

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Delivery Room Football

A poignant account of a new father who insists that his daughter, born via cesarean after more than 24 hours of unmedicated labor, remain with her mother. But the hospital staff said that their baby had to go to the nursery for a few hours for observation. So this new father, also a physician, intercepts his baby. From his essay Delivery Room Football:

“Hold on a minute!” I said. “I want her to go to her mother.” I looked over at Sandy’s exhausted, filmy eyes and the look of panic on her face.

“No, we’re sorry,” they replied firmly. “Hospital policy.” Having proclaimed this, they strode purposely forward toward the door just to my left.

Quickly I stepped in front of them, blocking their way. “Hospital policy or not, I’m her father and she’s staying here!”

Suddenly it seemed time began to slow. Looking back, it seems almost like some sort of bizarre operating-room football game. The doctor, with my child tucked under his right arm like a halfback, decided he would simply ignore this irrational father, take a step to his right and scoot on past my left elbow and through the swinging door. I don’t know what he expected I would do, but I certainly know his eyes looked surprised when I made my move.

Sensing his plan, I quickly stepped back so that my body was exactly in front of the door. My hands were on my hips so there was no room to go through. My fists were clenched and my knees were slightly bent. My heart was racing in my chest and my lungs were pumping air. I could feel my eyes narrow to slits and my belly tightened as my voice dropped about an octave. I growled more than spoke the words, “Nobody’s leaving this room with that child!”

They froze in their tracks. Their eyes told me that this was not an everyday experience for them. The doctor on my right tried one more time to run interference, a kind of “bureaucratic cross body block”. “You’ll have to sign papers saying that you’re taking this child against medical advice!”

I imagine that if I had not been an experienced physician, I might have faltered long enough for him to succeed in an end run after all. But I had delivered enough babies to know that this one was in no immediate danger. I felt not the slightest tinge of fear, only intense concentration, resolve . . . and a rising tide of fury.

On the other side of the room, beyond the pediatricians, I could see the tears in my wife’s eyes as she watched her only child being taken away before she had a chance to even see or touch it. In the doctor’s arms I saw Lauren’s mouth making sucking movements. I felt the irreplaceable seconds ticking away and could hesitate no longer. I stepped forward and extracted her from his arms. “You get the papers, and I’m taking my child.”

The interception completed, I stepped swiftly between them. In response to a sub-sonic growl, they parted like the Red Sea and I marched through. A moment later, Lauren was there on her mother’s arm nuzzling for the breast. The feeling of warmth, closeness, love and family was breathtaking. Suddenly all the pain, labor and danger faded from our minds.

Now, eleven years later, the remotely possible complications never having appeared, we are thrilled at the results of our steadfast attention to such “details.” Lauren is a wise, loving, active, good humored, secure and wonderfully compassionate being. We know that our role has been to make space for and nurture these inborn qualities.

(Photo from The Man-Nurse Diaries).

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Guest Post #2: Judgment, Fear, and Focus

Laureen is the technical editor and online community advocate for java.sun.com and developers.sun.com at Sun Microsystems, a freelance editor for Hunt Press, and a contributor to several peer-reviewed group blogs. She's a blogger, a podcaster, a website manager, and an enthusiastic geek enabler. She's the mother of two gorgeous children, and the wife of a man who understands her birth passion. She's had one iatrogenic unnecesarean, and one triumphant HBAC.

Judgment, Fear, and Focus

For only having two children, I have pretty much the range of birth experience; my first was a planned birth center birth turned hospital transfer with epidural turned cesarean. So there's the complete spectrum of medicalized birth. (At the time I was planning it, I thought my birth center birth was non-medicalized. I learned the hard way about medical midwifery.) My cesarean was brilliant, as these things go. The doctor was near retirement, had a 40% cesarean rate in his private practice, and knew what he was doing. I was too ignorant to even ask for things, but upon examination of my medical records, I got a Cadillac of a cesarean. Sheer dumb luck, that was. But despite that, due to hospital protocols, my baby spent the first four hours of his life with strangers; four hours we'll never get back.

For my second birth, I had an unassisted pregnancy, followed by a home birth with a midwife.

The move from home to hospital for birth in our culture involved a paradigm shift, whereby medical professionals convinced women that they were incompetent to birth without assistance, despite millennia of successful field testing to the contrary. The move to reclaim women's power by bringing birth back under their control is involving another paradigm shift, and that's going to be uncomfortable, and it's going to upset people. I think it matters that I know all kinds of women who've gone from hospital births to home births, but only two who've gone the other way, even if the home birthers ended up transferring ultimately. Because of my own experience, I am strongly biased towards home birth, and I admit that up front. On the other hand, because of the experiences of women I know personally, I would rather gnaw off my own arm than deny women the right to choose to birth in a hospital.

One of the things that really bothers me about the comment-foo on Rixa's blog is the complete abandonment of logic. Instead of classical logic, symbolic logic, the construction of actual arguments based on fact, we saw logical fallacies. Use of fallacy in argument invalidates the whole thing, in addition to bringing the entire discussion down to blows in short order. This does nothing to contribute to the betterment of women and babies; it sets us against each other for no purpose whatsoever. The thing about a good, solid, well-constructed argument is that invariably, both sides of the issue learn something and see further into their opponent's mindset. Everyone is bettered, perspective is gained, and we're that much closer to being a unified force...unified behind the true betterment of the situation here for mothers and babies.

I'd like to address a few of the real arguments brought up in the course of the commentary on Rixa's post...

Always be suspicious of motive when someone tries to make you do something that makes a lot of money for them

Maternity "care" is critical to the profitability of a hospital, and the more this can be managed, the more profit a hospital makes. The cesarean rate in the US is at levels so high (31.1% in 2006) that the World Health Organization considers it to be a "crisis." Scheduled cesareans are the epitome of optimally profitable managed birth. UnitedHealthcare sends maternity patients a brochure in late second trimester, offering them the option of a scheduled 39-week cesarean.

My cesarean, NICU stay, and hospital stay netted the hospital nearly $27,000, the anesthesiologists nearly $11,000, and a heap of other people other monies, and cost my insurance company a bundle.

My home birth cost my insurance company $3,000. Period.

So who stands to make money off my choice of birth? Hmm...

"You should be grateful you have a healthy baby/All that matters is a healthy baby"

Well, yeah, of course. But that's so not the whole story. Read Gretchen Humphries' brilliant essay "You Should Be Grateful."

There is room in this world for good experiences for both.

"Birth is about the baby, not the mother"

This letter, published in the ICAN eNews a little while back, says it all.

I am a lawyer who went to a top ten law school and then to a top tier firm. I used to be very mainstream in my views. I thought women who chose to give birth at home were reckless. When I got pregnant and was given the option of having a c-section, I readily agreed. I never went into labor and my c-section went flawlessly. I researched it, so I expected that my arms would be tied down, that I would likely shake from the anesthesia, and that I would not be able to hold my baby. That was ok, because I was ready for it. I handled the drugs well and, as a result, actually remember the first 24 hours. My recovery was uncomplicated.

My daughter, however, got the worst of it--which isn't even really that bad considering other stories I've heard. She was so sleepy and zoned out from the drugs that we had to put ice on her bare skin to wake her up enough to feed. She developed jaundice as a result of not eating enough. Because she couldn't feed properly (because she was so drugged), my milk never came in properly--which was a problem since it turned out she was allergic to all of the formulas they had. Given her allergies, breast milk would have really helped. She kept losing weight. She was diagnosed with failure to thrive. It was a very scary time, because we thought she might die.

On a long term basis, because she never came through the birth canal, her gut didn't get colonized with the right bacteria. That translates into the gut and immune system dysfunction she has today and the medicine that we give our 3.5 year old 5 to 6 times a day. She is also on a severely restricted diet--no wheat/gluten, dairy/casein, soy, citrus, etc. Bacteriologists say that the first germs that the baby is exposed to will set the tone for the baby's life. Those germs really need to come from the vagina.

The c-section went well for me, personally. I was very, very lucky as you will see from other stories you read. It did NOT go well for my daughter. I am now pregnant with a second child and plan to do all I can to deliver vaginally. A c-section still seems like an easy choice sometimes. Indeed, if I were giving birth to a tumor, not a baby, I might be inclined to do it, in spite of the crazy risks. But I will not put this baby at risk.

I'm a litigator and I love evidence. Crazily enough, the evidence is strongly in favor of vaginal birth. I believe that the cavalier attitude of OBs toward this major surgery is a result of a combination of factors (preference for control, fear of malpractice, higher payment, surgery is more "fun," lack of education on natural birth as opposed to how to manage an impending crisis, etc.). But carefully look at the evidence first, before you make up your mind. The evidence really does speak for itself and I'll let someone else who is better versed in the evidence point you in the right direction.

And with cesarean delivery, the baby itself is more likely to die. The US has the second worst newborn death rate in the developed world, despite the fact that we spend more money on "medical care."

How is it that we forgot that babies and mothers are a dyad? You can't truly separate the well-being of the mother from the well-being of the baby, not even with a scalpel. Go ahead; tell me that a mother who lives and a baby who dies, or a baby who lives and a mother who dies, deserve to be a separate statistic. I don't know a mother or a child in either circumstance who doesn't have a little bit of them die too, even if the statistics don't neatly account for it.

"But women used to die in childbirth!"

Read the news; they're dying now. Ask the families of Tatia Oden French, Valerie Scythes, Melissa Farah, Caroline Wiren, how they feel about the safety of hospital birth. Ask Claudia Mejia. Ask Amber Marlowe. Ask Dennis Quaid how safe hospitals are for babies.

Disaster can strike anywhere. But the idea that hospitals are inherently safe is not valid, and demonstrably so. There is no choice you can make that's an automatic get-out-of-jail-free card. The reason most women default to hospital birth is because that choice is presented as being blameless. If something happens in the hospital, well, that's just bad luck, but if it happens at home, that's bad decision making, with the mother occupying the role of bad guy, all by herself. This is not fact, this is not logic; this is marketing spin.

On Judgment

I have been told that my cesarean was a personal failure. I have been told that having a midwife present for my second birth was a personal failure. I have seen fully-medicalized birthers rip midwifery advocates apart, both live and online. I have seen women spend an ungodly amount of energy and time shredding at each other.

For what? I deeply believe that women who choose hospital birth do so because they want the safest and best for their babies. I deeply believe the same thing of the home birth set. So why are we still attacking each other?

Fear. And Judgment.

In the final analysis, birthing carries risk. Living carries risk. There are no guarantees anywhere that if you make all the "right" choices, you and yours will be saved from tragedy. Lightning strikes, and all the planning and research and analysis in the world will not save you from that. It comes down, in the end, to supporting each other the best we possibly can, to making our choices from a place of confidence, not a place of fear. If you're birthing in a hospital, do so because that's what feels safest to you. If you're birthing unassisted at home, do so because it speaks to you and feels right to you. Fear has no place in any decision about birthing.

A friend of mine who just had what she calls her "victorious homebirth after two cesareans" says:

Since our life-changing home birth I've encountered so much more support than we imagined possible. I cannot believe how many friends and acquaintances have said, "I sure wish WE had seriously considered birthing our children at home." Obviously there is a slow shift being made in the birthing climate of America. But there are also many other comments we've heard like, "I'm glad it worked out for you," which I now see as such a pitiful way to view birth--like it's a matter of luck. But I know that's the reality for most people. If these critics knew the amount of time, prayer, and research we put into this decision and into the type of provider we selected, they might have to consider why EVERYONE doesn't invest that kind of time and prayer in their own birthing decisions. For us, the search was priceless and ultimately put us in far better control of our decisions. And beyond the stats and truths we uncovered during this journey, we discovered something far more valuable: faith. After asking for guidance, begging for deliverance, and recognizing our answer, I was overcome with a peace that I have to say I've never experienced after praying before--and as the preacher's daughter I've spent a good many years on my knees in prayer. It was amazing to simply ask and to find the undeniable peace we so desperately desired. So THIS is what answered prayer feels like. I understand that's not much of a factor in modern society, which makes me incredibly sad.

We've also had to endure a number of horrible birth stories where someone nearly died "even in a hospital birth" (the fetal and maternal monitors didn't discover there was a problem until it was too late). I'm never sure how to take this kind of response to the introduction of our new baby. If these tactics are in an effort to get me to debate the home vs. hospital issue, I'm not taking the bait. My decision isn't up for debate--especially with those who've invested little in the search for truth other than personal experience and hearsay. I can respect your birthing decision if you can respect mine.

Standing together, we can do so much more good for everyone, than we can by compartmentalizing each other and shredding on anyone who doesn't share our precise set of birth circumstances. Different does not have to equal wrong. But the way things are right now, fear is controlling the cards, and we need to put down our differences, and stand together for a set of choices in birth and baby care that puts the U.S. back up at least in the top 10, because when it all comes down...the choice between home and hospital is not the point. The point is that women and babies are dying in utterly unacceptable numbers, and they're dying because our social, medical, and economic systems are not supporting women.

And women are not supporting women either. So let's focus on what matters.

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Guest Post #1

This first guest post comes from Sheridan Ripley, a proud VBAC mom of 3 busy boys, Loving Lactivist, Positive Birth Story Collector, Hypnobabies Instructor and Hypno-doula. She has several websites and blogs: Orange County Hypnobabies, Positive Birth Stories, and a Birth Blog.

I invited Sheridan to write a guest post because of some of the comments about LDS birth choices. At least one commenter asserted that TopHat and I were fanatical homebirthers and that we were not practicing what we preach when we chose unassisted births. I assert that, by following spiritual guidance and seeking Priesthood blessings for our pregnancies and births, we were definitely practicing what we preach. Sheridan's birth stories--as different as they are from my own--show how she also followed spiritual promptings.


Each birth is different and unique. Our views of birth change over time and with our experiences. Birth is unpredictable and that is part of its beauty. I have had 3 very different birth experiences. Each taught me something important and each changed me as a women and a mother. I learned that my intuition (or the promptings of the Holy Ghost) is one of my most powerful tools as a mother. This has proven to be true not just during my pregnancy and births, but also as I continue to raise my boys. The first part of my post focuses on my pregnancies and births.

My Births

Devon: I was hoping for a NCB (natural childbirth) with my first baby. I took a Bradley class and things were moving along nicely when suddenly I ended up on bedrest at 25 weeks for pre-term labor (PTL). I wasn’t able to finish my classes, but was still hoping to have a NCB. I ended up changing care providers at 27 weeks because I felt my OB was not listening to me and my concerns. I was in and out of the hospital 7 or 8 times. One day while driving, Rob and I started talking about why I this was happening, and we both felt there was a BIGGER reason than just the PTL. We might never know why, but it was important I was experiencing this. That brought me a lot of comfort, as it was pretty mind-numbing being on bedrest.

I woke up one morning at 34 weeks and noticed the baby wasn’t moving. I knew the importance of being aware of your baby’s movements from a TV show I had watched years ago. (I think this is the reason I was on bedrest; I doubt I would have noticed so fast the decrease in movement if I hadn’t been on bedrest.) I drank some juice and still nothing. I suddenly KNEW in my heart something was wrong with the baby. I really thought I had lost him. I called the OB who had me drink more juice and told me to call back an hour later.

I “obeyed” and after about 30 minutes with still no movement, I woke my husband up (he is a late sleeper) and was crying and told him something was wrong and we were going to the hospital no matter what they said when we called back. We got ready to go, called and they set up an appointment at 1:30 pm for a NST (non-stress test). I still wish I had truly followed my intuition and just gone in right then, but we waited.

My husband gave me a blessing to help calm me down. In it he blessed that Devon would be ok and that he would come when he was ready. As soon as he said he would be ok, I felt a large weight come off of my shoulders. I KNEW that the baby was going to be ok. The blessing brought me a lot of comfort.

We got to the NST place early but had to wait until they got back from lunch. They got me on the monitors; there was his heartbeat, and I thought everything was fine. They used a little noisy vibrator on my belly to try and wake him up. Devon kept on sleeping, but it made me have contractions, which made his heart rate drop. (I didn’t understand the significance of that at the time.) A new nurse came in and said we would be having our baby that day. I thought she was in the wrong room. Quickly it became apparent that there was a problem and it was safer for the baby to be out NOW.

We headed across the street to the hospital. Rob wanted to know if I wanted another blessing. I said I didn’t need one; the first one said he would come when he was ready, so I trusted that he was ready. My NCB dream was shattered. I was thrust into this emergency cesarean situation. I am grateful I was able to have a spinal so I was awake when Devon was born. He was 4 pounds 3 ounces. It was a very surreal and scary situation. I had been lying in bed for 9 weeks so the baby wouldn’t come early, and now I was having a surgery to get him out early.

I got to see him for a few minutes, and then Rob went to the NICU with him. I was left alone in the recovery room in a lot of pain and feeling so empty. It was not the birth I had hoped for, but the farthest thing from it. It took years to really get over it. But I knew it was a life-saving operation for Devon, so I was never angry. I always say that day was the scariest and happiest day of my life.

It is amazing what a mother will do for her child. If I said to you, “will you lie in bed for 9 weeks and then have a major surgery to help somebody you have never met?” odds are you would think I was crazy. But if it was for your baby of course you would.

So from this birth I learned that birth is unpredictable; we can plan for one thing and get something totally different. That there are moments in time that will be seared in our memory. That scary things can be happy things. That with sadness there can be joy. The most important thing I learned is that our intuition can save lives and we must listen to it and follow as we are led.

Carson: I had a lot of baggage from the first pregnancy and birth. I was scared, but I didn’t want fear to motivate me in my choices. My husband had seen a Dateline show on hypnosis and birth and suggested I look into it. I found a HypnoBirthing class an hour away and we took the class. I found it very healing, I was able to let go of my fears about carrying full term and about my ability to have a vaginal birth. I moved forward in this pregnancy with faith in my body. I think that had I not had these tools, I would have remained very fearful of pregnancy and birth, and that would have in turn affected my pregnancy and birth.

I was of course highly aware of Carson’s movements. I chose to have biweekly NSTs from 34 weeks on; they gave me a level of comfort that I needed. My goals for this birth were to go full term, to have a vaginal birth, and to double Devon’s birth weight, so I was shooting for an 8 pound 6 ounce baby. While I knew birth could be unpredictable and of course if an emergency arose I would do whatever needed to be done for my baby, I still wanted to focus on what I WANTED—my ideal birth.

I was pregnant for 42 weeks with Carson, 8 weeks longer than I had been with Devon. After Devon I had said, “I will never complain about getting big or going over.” Well, I had a lot of chances to prove it that was possible. I did get HUGE. I might have complained a bit, but overall I was content. I was hoping to go un-medicated for this birth. But after 14 hours of comfortable labor I lost focus and was having back labor, so at 17 hours I chose to get an epidural. This was the right choice for me at the time and I never regretted getting it.

After 21 hours of birthing time with almost 3 hours of pushing, my 9 pound 4 ounce baby boy was born vaginally. I felt exhausted but thrilled. I had done it! Carson was in my arms and I was so proud. It was a healing birth in so many ways.

Bryson’s pregnancy: I wanted to use hypnosis again, because I knew it could work, but I wanted more tools, so I found Hypnobabies. My main goal for this birth was an un-medicated vaginal birth. I knew I could do it.

At my 33 week appointment I said I wanted to get my NST scheduled. My OB said I didn’t need it; all was well. I wasn’t sure why, but I really insisted I get it scheduled. My intuition said I needed that. I pointed out a weird rash on my leg and my stomach was itchy. She brushed it off and said to go to my primary care physician. This led into the most challenging section of any of my pregnancies. Yes, it was even harder than bedrest!

I had PUPPS, a pregnancy-related rash, which care providers don’t seem informed about or really care about because there is “no medical effect” on mom or baby. Well, let me tell you it rocked my world and stressed me out to no end, and that surely had an effect on my baby. It took prayers, blessings and that NST to help me survive.

Labor Day weekend was coming up and that Friday I went to my first NST. I almost didn’t go because putting clothes on was painful. I knew the baby was ok, so I was tempted not to go. I really felt I should (intuition again). I got there and the nurses saw my belly, which by now was a red inflamed horrific sight. They quickly got the high risk OB, who diagnosed me with one of the worse case of PUPPS he had ever seen. I was thrilled that someone was finally listening to me and caring. He gave some prescriptions.

Now, I typically do not take even a Tylenol when pregnant. Each situation is different and I have learned not to judge others, because, let me tell you, I ran to the pharmacy and slathered that cream on my belly and popped a pill in my mouth. I was at the point where I would have signed up for a repeat cesarean at 37 weeks to make this rash end. Though I have since learned that birth does not always end PUPPS, I have also since learned of more natural remedies that can help PUPPS moms, including acupuncture, which I would certainly try first if I had it again. This is a great example of how limited information affects your choices. The medical establishment has one answer and that is drugs or intervention. When a woman is fearful or uncomfortable she makes that choice, because it seems to be the only one.

That night I had another blessing and continued with my prayers. The medicine helped, I still had PUPPS the rest of my pregnancy. I slept with socks on my hands, so I wouldn’t scratch myself to bleeding while sleeping. I was naked (well, loose PJs, no underwear) for the majority of the days, dressing only when I had to leave the house. But I was able to handle that compared to what it had been. I carried Bryson to 41.5 weeks. I only wish I had taken pictures. I still have scars on my legs. I can only imagine had I not gone to that NST I would have ended up in the ER over Labor Day weekend for a mental breakdown of some sort.

Bryson’s birth itself was the most amazing experience of my life. (You can read the complete story here or see the video here.) I had my husband, a doula, a good hospital with a supportive nurse, and my Hypnobabies tools. I had a completely unmedicated COMFORTABLE birth.

I woke up at 1 in the morning with pressure waves that would shock me out of sleep. I popped in a Hypnobabies CD and was able to “sleep” as long as a CD was on. It kept me aware enough that I could stay relaxed if a pressure wave came and I could stay comfortable. This allowed me to stay well rested. In the morning I just wanted to be left alone, so we got the boys off to school or with friends. I hung out, puttering around, wondering if this was really the day. (I had had days of prodromal labor.)

By 10:30 am I decided this was it. I was settled into my hospital room with my husband and doula by my side by 1 pm. I was comfortable and walking the halls, chatting between pressure waves. At 4:30 pm I choose to have my water broken, as I was still 5cm with a bulging bag of waters (which I had been at noon). Things quickly progressed and I was ready to start pushing around 6:45 pm.

I really loved pushing. I felt like a lion roaring my baby out. It was so powerful and amazing. I was still comfortable. The OB said, “You are going to feel the ring of fire now.” I remember thinking, “I haven’t felt any pain yet; no need to now.” And I bounced her comment right off my bubble of peace. (Hypnobabies tool.) I felt only pressure through the whole birth.

Bryson was in my arms at 6:59 pm, and he didn’t leave them for almost 2 hours. Here is what I wrote about it that night…

That was amazing, beautiful, a miracle. Everything I wanted and more. I feel so empowered that I gave birth, completely un-medicated to a healthy 9 pound baby boy. He came straight from inside me—onto my chest, where he stayed undisturbed for over an hour. The first 20 minutes or so his eyes stayed closed and he just hung out snuggled to my chest. Then he started rooting around. Someone helped me get him latched on—it is funny you forget how to do these things, he has a STRONG suck—he went to town—then slowly he started opening his eyes—looking around at the world—at me, his mom. It was honestly almost surprising to see a BABY laying on me. I actually have another baby of my own. I am so blessed. He looks like his own little person.

Bryson’s birth showed me the power of my mind and the power of my body. It was such an empowering experience. It has changed the way I think about myself and birth. I wish every mom could experience a birth like that.

My thoughts about birth as a spiritual event

Birth is a spiritual event in our lives. (At least it can be.) Pregnancy and Birth are an amazing time where a spirit is making this step of his journey into this mortal world. I know that the Holy Ghost can guide us as we plan our families, comfort us as we deal with losses, warn us if something is wrong, reassure us if all is well.

I think that it is a gift that not enough people use or trust. It can be a HUGE help as we plan our births, it can let us make the best choices for OUR family and THIS birth, even if it is different than what we planned or what we had chosen for our other births. We need to do our research, we need to make our choices, but the spirit can confirm if it is a good choice for us. It isn’t for me to judge what the best choice for others is. I am happy to share information and encouragement, but I will support them in what they chose is best for them. I can’t know what is best for their family, it isn’t my birth, it is their birth!

Birth is a learning event in our lives. (At least it can be) It has taken me 3 births and reading a lot of books to get to the point where I would feel comfortable having a homebirth. This comfort level also has a lot to do with what I have seen as a doula. Watching a birth as an observer rather than the birthing mom is very eye opening. It really shows how a mom in a hospital is just on a conveyor belt of institutionalized care, getting one size fits all care. It is sad and scary to me to see all that goes on in hospitals and how a lot of the routine interventions they do actually cause problems.

I also know that if I were planning a homebirth, but felt the need to switch to a hospital birth, I would follow that impression. I would trust that Heavenly Father would guide me in my next pregnancy and birth as He has guided me through my first three. I would trust that if I listen and respond to the impressions I receive, all would end like it was meant to.

It is important to respect others’ birth choices. The more I learn and have experiences the more I realize it is such an individual thing and all I can do is offer information and support. Three years ago if a friend told me she was planning an unassisted birth, I would have thought something along the lines of "that is crazy." I hope I would have been kind enough to say, "that is your choice and I wish you well." But today I can understand it and respect it. I would probably ask some questions and see what her motivation is. If she isn’t aware of supportive care providers, I would give her some names. Then I would support her in her choice. Since I have had fantasies of having an unplanned unassisted birth in my kitchen…I would probably share that with her. :)

Unassisted birth wouldn’t be my first choice for a future birth. But I know that if I were in a location where I couldn’t find a care provider to support me in a VBAC, I would choose an unassisted birth over a repeat cesarean. It would take a lot of prayer and blessings to be comfortable with that, but I personally couldn’t choose to have an elective cesarean if it was not medically necessary.

In the past I have had the same gut reaction of "that is crazy" to moms telling me they were planning cesareans. But today I ask questions and share information and then support them in their choices. It is such a hot topic and very emotionally charged. I have a whole series of posts on moms choosing cesareans on my blog.

So, this has been a very long post about birth choices and how each and every birth is different. We can learn from our own and from others’ choices. The most important part is that we can receive guidance from our intuition throughout our pregnancy and birth. If we trust birth, trust ourselves and make the best choices we can, the journey will be an empowering one.

Sheridan recommended a few birth stories that show the power of a mother's intuition:

Here is a GREAT birth story about a mom who was planning a home birth and early in her birthing time she knew she needed to go to the hospital.

Another great story, planned homebirth, but mom doesn’t feel right about it when things start, so she goes to the hospital. Turns out baby is breech, but she has a vaginal breech birth, with a doctor who keeps his cool and supports mom in her choice.

FAST planned homebirth story, midwife didn’t have time to get there. There is a scary moment of baby getting stuck, BUT mom listened to her intuition and it ended great.

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Vision of Unity

I have been disturbed by all of the antagonism, fighting, gossip, and divisiveness that envelops childbirth. So many of the choices surrounding birth are framed in terms of polarized debates: home versus hospital...midwives versus doctors...epidural versus "natural" childbirth...assisted versus unassisted. Rarely does either party walk away having accomplished anything positive. We wield studies and statistics like clubs, hoping that we can intimidate each other into submission by sheer force or volume or rhetorical ingenuity. We hurl horror stories at each other: woman catches fire during her cesarean! baby dies during a breech homebirth! two best friends die after their cesareans! woman loses both arms and legs after giving birth in a hospital!

I cannot take part in this violent war of words. Mothering has transformed me. I never knew that I could love so passionately and so completely. Happy Sad Mama's words echo my own feelings: "I love my kids so much, so intensely much, and I am so grateful for them that my image that flies past the blackness of my eyelids when I think too hard about this love is of me lying, face-down, on the ground reaching up for them. I want them so intensely interwoven with me, I feel absolutely addicted to them and entranced by them and I just can't imagine that everyone else in the world feels this way because I am almost CRAZY with the love and addiction for them."

When I was pregnant with my daughter, I felt an intense inner need to give birth to her at home, in privacy. When a reporter from Grazia magazine was interviewing me last spring, I unexpectedly broke into tears as I was telling her how I had wanted Zari to be born in an atmosphere of love, knowing only the warmth of her parents' arms. I am not a crier, usually. I didn't cry at my daughter's birth. I was calm. Intensely happy, of course, too, as you can see in the videos right after her birth.

I feel a kinship with Sarah Buckley in this regard. She too felt a strong inner pull that her fourth baby needed to be birthed at home, into the presence of her own family: "Our baby’s birth was to be witnessed only by the family--there had been a strong feeling from the start that this was what this baby wanted....There was also a simple, domestic feeling to this pregnancy--no need for outside activity or people--and I felt keenly this baby’s love of family." The birth story is definitely worth reading, by the way.

Love is a tremendous motivating force. I challenge you to join me in transforming our verbal swords into plowshares. Let's turn the endless debates into something more beautiful and more useful: a Vision of Unity.

VISION of UNITY
by Jeannine Parvati Baker

Like many of us, I have been praying with my ears, listening to midwives all around the world.
How can we (wo)manifest the vision of unity that would serve families?
Meditating upon the divisions between birth attendants, a vision came to me.
I saw a circle wherein the tribes called to heal the Earth by healing birth sat together.
It was a medicine wheel, with all styles of midwifery and obstetrics represented.
Across the wheel from me sat a medical doctor.
To each of my sides were medwives and CNM's, seated across from one another.
We defined the cardinal points in the wheel, but were not the whole circle.
From where I sat, I could see directly what was behind the doctor, and visa versa.
To either side I had an oblique angle to view my sister medwives and CNM's.
Then I realized why we needed one another. It is to keep us honest.
I can see what is the shadow of obstetrics, as the good doctor can see the shadow freebirth casts.
Nurses and medwives add to the bigger picture across the wheel from one another.
No one can turn around and see ones own shadow alone. This is how we serve one another.
All of us who attend birth are holograms in this circle of life. Each has the whole truth about birth within.
When we bring our versions of the truth together, there is a finer resolution and
multi-dimensional viewing into the great round of being.
In my vision, we are sitting in birth's circle, representing our various tribes.
Not my circle, not yours, but birth's circle.
Each tribe, each perspective, is precious to birth.
Together the living oracle will be voiced through all of us.
Let it be the voice of what the Earth needs through each of us.
Remembering this always: What we do to one, we do to all.

(http://www.freestone.org/hygieia)

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